Trends in the Ambulatory Management of Headache: Analysis of NAMCS and NHAMCS Data 1999–2010 John N. Mafi, M.D.1, Samuel T. Edwards, M.D.2, Nigel P. Pedersen, M.B., B.S.3, Roger B. Davis, Sc.D.1, Ellen P. McCarthy, Ph.D., M.P.H.1,4, and Bruce E. Landon, M.D., M.B.A., M.Sc.1,5 1
Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; 2Section of General Internal Medicine, Veterans Affairs Boston Healthcare System, Boston, MA, USA; 3Department of Neurology, Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA; 4Office for Diversity Inclusion and Community Partnership, Harvard Medical School, Boston, MA, USA; 5Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
BACKGROUND: Headache is a frequent complaint and among the most common reasons for visiting a physician. OBJECTIVE: To characterize trends from 1999 through 2010 in the management of headache. DESIGN: Longitudinal trends analysis. DATA: Nationally representative sample of visits to clinicians for headache from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, excluding visits with “red flags,” such as neurologic deficit, cancer, or trauma. MAIN MEASURES: Use of advanced imaging (CT/MRI), opioids/barbiturates, and referrals to other physicians (guideline-discordant indicators), as well as counseling on lifestyle modifications and use of preventive medications including verapamil, topiramate, amitriptyline, or propranolol (guideline-concordant during study period). We analyzed results using logistic regression, adjusting for patient and clinician characteristics, and weighted to reflect U.S. population estimates. Additionally, we stratified findings based on migraine versus non-migraine, acute versus chronic symptoms, and whether the clinician self-identified as the primary care physician. KEY RESULTS: We identified 9,362 visits for headache, representing an estimated 144 million visits during the study period. Nearly three-quarters of patients were female, and the mean age was approximately 46 years. Use of CT/MRI rose from 6.7 % of visits in 1999–2000 to 13.9 % in 2009–2010 (unadjusted p
Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; 2Section of General Internal Medicine, Veterans Affairs Boston Healthcare System, Boston, MA, USA; 3Department of Neurology, Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA; 4Office for Diversity Inclusion and Community Partnership, Harvard Medical School, Boston, MA, USA; 5Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
BACKGROUND: Headache is a frequent complaint and among the most common reasons for visiting a physician. OBJECTIVE: To characterize trends from 1999 through 2010 in the management of headache. DESIGN: Longitudinal trends analysis. DATA: Nationally representative sample of visits to clinicians for headache from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, excluding visits with “red flags,” such as neurologic deficit, cancer, or trauma. MAIN MEASURES: Use of advanced imaging (CT/MRI), opioids/barbiturates, and referrals to other physicians (guideline-discordant indicators), as well as counseling on lifestyle modifications and use of preventive medications including verapamil, topiramate, amitriptyline, or propranolol (guideline-concordant during study period). We analyzed results using logistic regression, adjusting for patient and clinician characteristics, and weighted to reflect U.S. population estimates. Additionally, we stratified findings based on migraine versus non-migraine, acute versus chronic symptoms, and whether the clinician self-identified as the primary care physician. KEY RESULTS: We identified 9,362 visits for headache, representing an estimated 144 million visits during the study period. Nearly three-quarters of patients were female, and the mean age was approximately 46 years. Use of CT/MRI rose from 6.7 % of visits in 1999–2000 to 13.9 % in 2009–2010 (unadjusted p
